Oral Answers to Questions

John Leech Excerpts

Tuesday 25th February 2014 Commons Chamber

[Dr Poulter]

We have had many debates in this House about group B strep and the effects of the disease. The point about enriched culture medium testing is that it takes time for bacteria to grow in culture, and the fact is that there is also evidence from the Royal College of Obstetricians and Gynaecologists. Public Health England has looked at that evidence and it has decided that it is not a test that is effective to be introduced during pregnancy. That is the medical evidence and we have to be guided by it. There are many other things that we need to do about group B strep, not least supporting the development of a vaccine, which is ultimately the best way forward.

[Mr John Leech (Manchester, Withington) (LD)]

Will the Minister tell the House what assessment he has made of the impact of the Immigration Bill on the maternity care of vulnerable women who would be expected to pay for their care?

[Dr Poulter]

Of course we need to have a health service in this country that is self-sufficient, and we have a national health service, not an international health service. However, it is right that we ensure that we look at all areas of the health service when we are applying new policies and directives, and make sure that we protect vulnerable patient groups. That is exactly what the Government are doing and we are working with the NHS to ensure that women always receive high-quality maternity care at the point of need.

Children and Families Bill

John Leech Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

The hon. Gentleman anticipates the debate to come, during which the Government will listen carefully to the range of views expressed by Members on both sides of the House.

[Mr John Leech (Manchester, Withington) (LD)]

When the House decided to ban smoking in pubs and clubs, we were told exactly the same thing—that that would not be enforceable—but it has proved to be perfectly enforceable.

Tobacco Packaging

John Leech Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr John Leech (Manchester, Withington) (LD)]

I am delighted to have a chance to speak in this Back-Bench debate, and I add my congratulations to the hon. Member for Harrow East (Bob Blackman) on securing it. I will make a few brief comments because many issues that I would have mentioned have already been covered by other right hon. and hon. Members.

I absolutely support the principle of standardised packaging of tobacco. I believe that it should have been introduced a long time ago and that it should have had a higher priority than a ban on point-of-sale displays. That is because introducing standardised packaging would have resulted in the end of displays of cigarettes, as the adverts that those displays created would no longer be created by standardised packets.

The decision not to proceed with standardised packaging has rightly been criticised. Questions about whether advisers have unduly influenced senior Conservative politicians are perfectly legitimate and do not seem to have been properly addressed. However, equally disturbing are the interventions by the unions, with bogus claims that standardised packaging will result in significant job losses in the packaging industry. I would have hoped that Labour Members would be just as vocal in condemning those interventions as they have been in questioning the influence of Conservative party advisers, but sadly not.

The Government’s argument for delaying a decision on standardised packaging was based on a perceived lack of empirical evidence that it would discourage young people from taking up smoking. I would have thought the fact that the tobacco industry has spent hundreds of thousands of pounds, and more, in trying to lobby against standardised packaging would be evidence enough. Why would it spend so much money on trying to stop something happening if it was not going to have an impact on levels of smoking?

If that is not evidence enough, may I bring to the Minister’s attention early-day motion 559, in my name, which highlights research by the British Heart Foundation into standardised packaging for cigarettes in Australia? It interviewed 2,500 young people and found that more Australian teenagers than UK teenagers had been discouraged from taking up smoking, owing to the standardised packaging. Fifty-nine per cent. of Australian teenagers said that standardised packaging deters them from smoking, and 77% of UK teenagers and 66% of Australian teenagers support it. If that is still not enough for the Minister, perhaps she could look at the findings of the study by Cancer Council Victoria, which showed that when young people view packs stripped of colours and logos, they believe that the cigarettes are lower quality, will taste worse and are less appealing.

In my opinion, the evidence is clear: standardised packaging does discourage young people from taking up smoking, and we should introduce it without delay. However, may I suggest to the Minister that we go one step further? A lot of research was carried out to work out the most unappealing colour scheme for the packaging. I think we should extend this to the cigarettes themselves, and as well as having grotty green-brown packets, we should have grotty green-brown cigarettes.

Health and Social Care

John Leech Excerpts

Monday 13th May 2013 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the hon. Member for Bosworth (David Tredinnick), who care passionately about health care in its widest and broadest sense.

This Gracious Speech is unprecedented. I cannot recall in all my years of working in this place, dating back to 1977, another instance of a Prime Minister saying it is okay for their party to vote against the Government’s programme. I cannot see the late Baroness Thatcher condoning such a move. This coalition Government are in meltdown, and the public must be wondering whether any of the proposals in the Queen’s Speech have the wholehearted support of their Members.

That said, there are measures in the health Bill that could and should be shaped and improved on a cross-party basis. It is therefore important that adequate time be allotted for the various debates and the Committee stage. The proposed programme is hardly onerous, so the guillotining of Bills should not be required—unless the Government decide that they dare not encourage full debate, and chicken out. We shall see.

Before moving on to the health-related elements of the Gracious Speech, I would like to mention the draft consumer rights Bill because it revisits the private Member’s Bill introduced by my father—Michael Ward, who was a Member of Parliament—which became the Unfair Contract Terms Act 1977. He was supported by the late David Tench in enacting what was groundbreaking consumer legislation. Lord Denning, the then Master of the Rolls, described it as

“the most important change in civil law”.

My father would, if he were alive, be very keen to ensure that the streamlining and simplification process in bringing together so much consumer legislation does not water down consumer rights.

There are a number of health-related proposals in the Queen’s Speech. In Plymouth—a mesothelioma hot spot because of the nature of its industrial base—people will welcome the further progress that has been made on speeding up the process through which insurance companies accept liability and pay compensation. However, for too many of my constituents progress has been tragically slow: they have not survived this awful disease long enough to benefit from the legislation. We have a moral duty to do everything we can to support the victims, and we need to ensure that the Bill, which has had a very slow gestation—it was discussed under the last Labour Government—does what it says on the tin and guarantees faster pay-outs. The failure to address other asbestos-related diseases is also giving rise to concern.

Those who are more fortunate are now, with support, living into grand old age, and we have to resolve the issue, which has dogged successive Governments, of providing care for our older citizens, as well as younger people with illness or disability. The care and support Bill should be welcomed as a step in the right direction, but I fear it will not be enough and, rather than having a full-blown national care service, we will end up with a piecemeal one. The level of the cap has been set too high—higher than Andrew Dilnot recommended—and without investment in local services the Bill will have serious consequences, as clearly set out in the opening speech by my right hon. Friend the Member for Leigh (Andy Burnham).

To deliver much of what will need to be delivered, local authorities will therefore be required to step up to the plate—the joined-up care that the Secretary of State talked about. Yet we know that many are having to dismantle the architecture upon which good care and support is offered—as we are seeing in Torbay, an exemplar—because of the deep cuts being made to their budgets. Can the Government please be clear about who will be running these care and support networks? If it is the private sector, how will they ensure that there is not a postcode lottery?

Oddly, earlier the Secretary of State was behaving like one of those nodding dogs we see in the backs of cars when it was pointed out that hospitals are under pressure and staffing levels are not all they should be. However, he has provided no real answers in this Queen’s Speech.

At long last, after almost four years, we have a Bill paving the way for a potentially dramatic change to the way defence procurement is carried out. There is consensus across the political divide that successive Administrations did not sufficiently reform defence procurement. Equipment programmes were overheated in respect of funding, and the Ministry of Defence was underpowered in the skills required to deliver increasingly complex programmes. There are too many questions that need to be asked for the time available, and today is not about defence, but we will need to come back to those questions. The themes, however, are the accountability of the proposed GoCo —Government-owned, contractor-operated organisation —and where the risk lies. For example, does it lie with the taxpayer or with the private company? Warning bells are already ringing around Westminster about the management of risk. We know from successive Public Accounts Committee and National Audit Office reports that the MOD struggles when it comes to assessing risk. We need to know whether the Ministry of Defence, like the Department of Health, is producing legislation that removes the Secretary of State’s power to intervene and take responsibility.

Finally, I come to the Bills that were not mentioned. My right hon. Friend the Leader of the Opposition emphasised the missing legislation in his response to the Loyal Address. The cold hand of the Prime Minister’s henchman, whose links to the tobacco industry as a lobbyist are well documented and who has accepted major donations to his campaign in Australia from British American Tobacco, is writ large on this Gracious Speech.

[Mr John Leech (Manchester, Withington) (LD)]

I agree that not having legislation to introduce standardised packaging for tobacco products is the wrong decision, but does the hon. Lady agree that it is appalling how the unions, too, have tried to stop this legislation?

[Alison Seabeck]

People work in those industries, and, understandably, the unions representing them have to consider the membership’s point of view. Among the unions as a whole, there is a broad range of views, very much reflecting those in this place today.

Returning to my point, perhaps that is why No. 10 has U-turned, from a position where it was wrong for children to be attracted to smoking by glitzy designs on packets and there were statements that children should be protected from the start, to the obverse position, where we are not being allowed to have legislation that would have a beneficial impact on the future health of our population and on the NHS budget. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, we need to know who is pulling the strings in setting Government policy. The Government have bottled it; they are in thrall to their right wing. Young people in Plymouth, particular our Youth Parliament members and those in our youth cabinet, who wanted very much to see this change brought forward, will feel that they have been sold down the river. Many young people are asking what is in the Queen’s Speech for them; there is nothing to protect their future health and nothing to help them into work.

If the Government were serious about improving the health of the nation, we would have given these measures a fair wind. They would have had broad support from the Opposition, as would investment in other areas, such as housing that is affordable to rent, because good housing equates to good physical and mental health. Nothing has been said on those issues. The Queen’s Speech is a huge missed opportunity, and it is simply not good enough.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

It is a delight to follow the hon. Member for South West Devon (Mr Streeter). I might not have agreed with everything he said, but he was right to point out that away from this place people’s concern is about economic growth. Sadly, the Queen’s Speech does not adequately address that concern.

Some of the less thoughtful contributions have demonstrated just how deeply divided this Government are—not between parties, but within the main party of government. The Prime Minister is unable to command the support of his own party. When he makes a decision, it is often the wrong one, putting party squabbles before national interest.

Just for one moment, let us imagine the scene in Washington today. The Prime Minister is there to seek the ear of the President on the EU-US trade deal, which is hugely important to this country and worth £10 billion a year. As the President received his pre-meeting briefing, I wonder what his advisers would have been saying: “Don’t waste time on this Prime Minister, Mr President. He has only two years left. He can’t even command the support of his own party. His Cabinet members are speaking out against him as they jostle for succession, and he has even told members of his own Government that they can vote against him on the Government’s programme. We will have to talk to the people who count in Government—ignore this one.” As Barack Obama raises his eyebrows in incredulity, British influence disappears out of the window because of the weakness of this Prime Minister.

That situation is also demonstrated in the Queen’s Speech, and as much by what is not included in it as by what is. When the Prime Minister makes a decision, too often he buckles under pressure from the wrong people, backing powerful vested interests against those of ordinary people. As a number of my colleagues and a number of Government Members have done, I want to highlight the absence of the promised legislation for standardised cigarette packaging, which sacrifices the health of our children in favour of the profits of the big tobacco companies.

Back in February, the Prime Minister talked clearly about introducing legislation for standardised packaging. The papers reported that

“Ministers are convinced that the ban is necessary to take the next step to reduce smoking in the UK.”

Those reports were confirmed by a senior Whitehall source, who said:

“We are going to follow what they have done in Australia.”

The source correctly went on to say:

“The evidence suggests it is going to deter young smokers. There is going to be legislation”.

That was what we were all expecting, although perhaps some of us were surprised that the Government had actually got it right on this issue and were putting people first—that was, until just a few days ago. I do not know whether they were under the influence of Lynton Crosby—bear it in mind that he earned considerable sums of money from the tobacco lobby, and that he failed to win the argument against standardised packaging in Australia before bringing his toxic approach to politics here—or perhaps they were just running frightened from the UK Independence party’s opposition to public health measures against smoking.

[Mr Leech]

I note that the hon. Gentleman does not mention the intervention of the unions and their support for retaining the existing system of packaging. Would he like to condemn the position that the unions have taken on standardised packaging?

[Paul Blomfield]

My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.

The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.

Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.

Cancer Treatments

John Leech Excerpts

Tuesday 19th June 2012 Westminster Hall

[John Pugh]

I am sure that the hon. Gentleman is right and that he is also aware that there have been debates about screening for cervical cancer, breast cancer and so on, and about the age at which that should be done and the effect it would have. Although it is possible to screen everybody all of the time, that is not the most rational way to use resources, so any screening programme needs to be judged in the light of its subsequent evidence, which is very strong indeed for the bowel screening programme.

I was slightly, not amused, but distracted by the recent Department of Health advertisements—there were big adverts on buses—stating that anyone who has been coughing for three weeks should definitely go to see their doctor, because they might have lung cancer. When the advertising programme was launched, a horrible virus had gripped my office, the most lingering symptom of which was a cough that lasted for three to five weeks. Had we all trooped to our doctors’ surgeries saying that we might have cancer, a good deal of national health service time would have been wasted. Any campaign needs to be sophisticated and reviewed in the light of evidence. The one thing that we do not want a public health campaign to do is provoke alarm, because that would distract doctors from the things that we genuinely want them to address. People are not slow to be alarmed by any suspicion of cancer, which, I believe, after pornography and some other subjects, is one of the most researched topics on the internet. It is frequently referred to on various medical sites as a suspicion, rather than a diagnosis.

The academic community also has to prioritise. A lot of people leave substantial amounts of money for cancer research and it needs to be used as effectively as possible, as do welfare payments to cancer patients. Those issues need to be prioritised—Members may care to discuss that in the context of the Government’s ambitions for the outcomes framework.

I want to concentrate on the connection between treatment and health policy. The clinical armoury and tools available to medical science are pretty well known and can be put under four headings: chemotherapy, radiotherapy—possibly supplemented by more sophisticated treatments, such as proton beam therapy—drugs and surgery. A cocktail of those methods is used to treat cancer. All, in their place, can be extraordinarily useful and effective interventions, but the key thing that determines whether they have the maximum effect on and benefit for patients is whether they are used with skill—the right skill at the right time in the right place, and probably in the hands of the right doctor or consultant.

I learned relatively recently that, although we talk broadly about categories of cancer, there are sub-categories within those categories, and not every sub-category is responsive to the same treatment. Knowing which treatment is best tailored to which patient is a genuine art, because patients and their histories are all very different, as are the remedies that work with them.

Improved outcomes are to some extent determined not simply by having the tools but using them with better and greater skill. It is the skill or its absence that explains differential outcomes. There are differential outcomes across the UK. The chance of recovering from certain cancers in some areas is greater or less than in others. The chances of acquiring certain cancers appear to be greater in some areas than others. Genuine skill—knowing what to use on what person at what time—is in extraordinarily short supply. That sort of skill, the really effective intervention, is often allied with establishments that not just treat cancer, but research into cancer. Great skill is often, not unsurprisingly, aligned with a greater understanding of what is being dealt with. Treatment of cancer is not usually a journeyman matter or one of bog-standard clinical intervention and practice. That is why organisations such as the Christie hospital have such a well-established reputation.

I know the Government have put extra money into the drugs fund. Using the right drug in the right place at the right time is a fairly refined process. People can be given drugs that work with a cancer in general, but not for that particular patient or not at that stage in the disease, by organisations relatively unaware of the futility of the intervention. Therefore, we have all understandably come to the conclusion that we need clinical networks. We need to have people dealt with in the appropriate centres of excellence. There is a genuine readiness by patients to travel as far as they need to get the treatment. Most people in my constituency who contract any form of cancer travel across Liverpool, normally to Clatterbridge on the Wirral, generally without too much complaint, to get the treatment they want. The same group of constituents has been extremely angry and provoked by the need to travel 11 miles down the road for A and E assessment and triage.

[Mr John Leech (Manchester, Withington) (LD)]

My hon. Friend may not be aware that the Christie hospital has opened satellite centres in Oldham and Salford, so that patients do not necessarily have to go all the way to Christie, as they would have had to in the past. They still get Christie service, but in their local community in Salford or Oldham.

[John Pugh]

I think that is becoming the common pattern and could create some problems, given the way we intend to structure the NHS. However, it is a wholly desirable pattern. Clatterbridge is looking at a similar arrangement across Liverpool in collaboration with the Royal Liverpool University hospital. There is a sensible willingness on the part of the ordinary district general hospital to refer patients into an area where the maximum competence exists and where it is a matter of life and death. That is a totally laudable example of integrated service.

We can all accept there is a need to have an adequate clinical network, particularly for the more common cancers—lung, colorectal, prostate and breast cancer—in pretty well every area. That is a template that either is rolled out across the land or we wish to see rolled out around centres of excellence. We must always bear it in mind that, with cancer, a certain number of standard procedures can be done locally, without the full expertise of the top consultant.

There are certain cancers where that is not the case, for which we need national centres of excellence. To return briefly to the Liverpool Cancer Research UK Centre, that deals with pancreatic cancer almost as a speciality, with people there researching it very intensively. Its view is that there are probably about only two cases in the UK—and there may only ever be, given the relative distribution of that disease—where whatever treatment the patient gets can make a difference to outcomes, because the cancer is almost invariably fatal. It is necessary to vary the mix depending on the cancer in question. However, for the most common cancers, having a centre of excellence, having hubs around which standard procedures can take place and having a clinical network that works, is the way to go.

That sort of network does not happen by accident. Other hon. Members, apart from me, have asked how under the new regime it will be maintained and sustained. The construction of such networks in the past was the function, duty, mandate and overview of the strategic health authorities and they, of course, are to go. I saw in the notes that they would still be dealt with under the strategic health authority bundle within the NHS Commissioning Board. Clearly, “strategy” is the word to be used here. The hon. Member for Leicester West (Liz Kendall) was fond of saying that during the passage of the Health and Social Care Bill. The key point is that the strategy and the template are clear; the question is how to get them in place, sustained and maintained over time under the new regime. I would like the Minister to reassure me on that point.

It is not obvious how such a desirable template would emerge through simple market forces, or through bottom-up agreements by local commissioners. Even if those things could happen, it is not obvious that that would represent the most secure or quickest way to bring about the outcome. That is especially so when one acknowledges that the best treatment often occurs in environments where there is not only integration between providers, but research is taking place. I repeat the point that there is a need to deliver various levels of intervention and care in various settings. That will not happen by accident, or without some institutional resistance. One proposal in Liverpool is to move some of the activities currently conducted in Clatterbridge to the Royal hospital and get very substantial funding for that. That proposition, though supported by the bulk of people, is not supported by all. A certain amount of controversy may still arise about the level of care that could be delivered or result from such changes, which are not effortlessly brought about.

I guess that I am trying to say that ironing out the inequalities in cancer outcomes, ensuring there is the same provision and that each network is as good as any in every area, is possibly susceptible to a more dirigiste approach or Stalinist-like solution. I understand that the chief executive of the NHS was once a member of the Communist party—I hope I am not maligning him. That approach has its attractions. If the NHS Commissioning Board, which shelters the skeletal remains of the strategic health authorities, could play a dirigiste role, acting like the Politburo to impose the right template in every place, one could see how facilities could be aligned and personnel put in the right place. There would also be an opportunity to use central funding to effect. The Government have set up some central funding both for drugs and other purposes.

I have no issue with that way of doing things, provided it is rendered accountable. However, under the new dispensation, I can see problems in going down that particular road. Some of the provision we would want in place, for example, proton beam therapy, will require substantial capital investment. Under the new regime, if I understood what the Minister said during Health questions, substantial capital investment is primarily the responsibility of providers. So we have to hope that, in all places across the UK, all providers dealing with the common cancers feel obliged to make the same level of investment. I am not sure that there is an easy way to ensure that that happens. Clearly, the NHS Commissioning Board can commission clinical networks, just as it can commission any other piece of health provision. However, providing a substantial capital grant to a provider might create problems, particularly if it is contested by other providers. Providers may be reluctant to provide the kind of intensive capital resource that might be required when they have budgets to meet and control.

Last Tuesday, an hon. Member talked nostalgically about the days when we used to have fundraising for all kinds of scanners in hospitals. That does not seem to have taken place in the past decade or so because the money has been flowing a little more plentifully. However, we could be back in that territory if providers have difficulties in acquiring appropriate capital investment, or do not see a business case for doing so, without subsidy, by themselves.

I imagine that there are concerns about patterns of referrals within clinical networks, which, again, will test the new system. For example, dermatology providers that are unable to cope with cancer and oncology outcomes—there are such dermatology providers; I think they are now called Virgin Medical—will, under any willing provider, be one of the first ports of call for referrals, especially if they have partners in GP practices who are inclined to use them. At the same time, that may not be the right thing to do clinically, given its complexity. As incidences of melanoma have increased, it may be far better to refer people not to a dermatology provider that cannot do oncology, but to a dermatology provider that can—essentially, the existing hospital base. I can see that being a good thing clinically, but something that is contested in practice if it becomes a settled pattern.

I think we all know where we want to get to. I know that many other things need to be said and I hope other hon. Members will say them. My question is, given that there is a whole raft of agreements and evidence about the objectives and the point at which we want to end, how, under existing or future arrangements, will we ensure that the best outcome is delivered? In other words, how do we get the right clinical configuration to achieve the right clinical outcomes?

Oral Answers to Questions

John Leech Excerpts

Tuesday 26th April 2011 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

1. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[Mr John Leech (Manchester, Withington) (LD)]

14. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

[Anne Milton]

I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

[Mr Leech]

The report highlighted that, for an investment of less than £30,000, Manchester primary care trust could ensure that all muscular dystrophy sufferers, including my constituent Ben Dale, have access to specialist care adviser support, saving an estimated £5 million in hospital admissions costs. Does the Minister agree that that investment would be excellent value for money, given that it would help my constituent Ben to live a more fulfilling life and save money for the NHS?

[Anne Milton]

The hon. Gentleman specifically mentions a constituent of his, and I have every sympathy with people coping with muscle-wasting diseases, and indeed with their families. The burden can be quite considerable. The multidisciplinary group that examined services throughout the north-west deserves our thanks for its work, but the fact is that it is for NHS commissioners, PCTs and the emerging GP-led consortia to consider the evidence that they have. Indeed, if money can be saved by commissioning services in a different way, so they should be, but that decision should be taken locally.

Health and Social Care Bill

John Leech Excerpts

Monday 31st January 2011 Commons Chamber

[Mr John Leech (Manchester, Withington) (LD)]

I am delighted to have an opportunity to speak, given the number of Members who wished to contribute. I will keep my comments brief.

We should all recognise that NHS staff do a great job in looking after our health and well-being, and are constantly striving to improve provision. I refer not just to front-line health workers, but to the office staff managers and professionals who are not always referred to so positively by either politicians or the media. However, we must also recognise that the NHS must continue to improve and do a better job in order to keep pace with rising health care needs. The question we must ask is whether the Bill will allow the health service to continue to improve.

Some positives have come out of the proposals. For too long, unelected officials have made decisions about local health care without listening to local communities, handing contracts for GP practices to private firms or even closing hospitals with local people locked out of decision making. In my constituency, under the previous Government, the PCT closed Burnage walk-in centre without any consultation. It said that this was to save money, despite the centre being more cost-effective than other walk-in centres in Manchester. This was part of the £20 billion efficiency savings demanded by the previous Labour Government. More recently, the PCT has temporarily closed Withington walk-in centre, again without consulting anybody who uses the service. So it is to be welcomed that the Government will not allow a service reconfiguration where the public have not been engaged and where it will reduce people’s health care options locally.

It is also to be welcomed that private sector providers will be expected to appear before local authority health scrutiny committees—that did not happen under Labour’s less democratic system. However, I urge the Secretary of State and Ministers that if private providers remain reluctant to participate, they should be mandated to appear before health scrutiny boards. Getting information on how providers are performing out into the open can only help to improve health outcomes and accountability.

The Lib Dem manifesto promised an end to the rigging of the market in favour of the private sector that we had seen emerge under the Labour Government. The Labour Government pushed for more NHS work to be given to private hospitals, regardless of local decisions on whether it was right for them. Much of the concern about the Bill centres on reforms being seen as being about the break-up of the NHS. Such a view is wide of the mark, because in many ways the proposals will level the playing field for the NHS, which was distorted under the previous Labour Government. They guaranteed that for-profit providers of elective surgical procedures running independent sector treatment centres would be paid a certain amount, regardless of how much work they did, and allowed PCTs to make supplementary payments to new private sector providers to make services more attractive to new entrants. Unfairly stacking the system in favour of the private sector and against public provision was wrong. We cannot allow certain providers to be handed work regardless of what patients want and regardless of the quality of the services provided. I hope that the Minister will confirm that preferential payments and guaranteed payments for new private sector providers will end. Can he also confirm that there will be no target for the proportion of work undertaken by private sector providers, unlike under the Labour Government?

However, there are still areas of concern and many questions remain unanswered. I would be grateful if the Minister explained what will happen to existing PCT-owned provision? Locally, in Manchester, the Labour party has claimed that the PCT-run Withington community hospital will close under these proposals. Of course that is simply not true, but questions do remain over who will own and run the community hospital. When I met the chief executive of Manchester PCT, she made it clear that the new proposals give real scope for widening and expanding provision through the community hospital, but she remained unclear on the model of ownership. I would be grateful if the Minster cleared that up.

Unlike Labour Members, I have no ideological opposition to the idea of allowing hospitals to extend their private provision. Private provision has been extended at the Christie hospital, in my constituency, which is providing millions of pounds extra each year to be reinvested in NHS provision, which surely is a good thing. However, I would be grateful if the Minister assured the House that where private provision is extended, it will not be at the expense of NHS provision. We should allow hospitals to extend private provision—in addition to existing services and certainly not instead of them—so that more money can be reinvested in the NHS.

Questions also remain about the cost of the implementation of change. Manchester used to have three PCTs, but they were merged into one to save money. The new consortia will go back to using the “three model”, and I am not convinced that that will save money. There is also a concern that intense competition for providing services that existing hospitals provide will take away resources and make it more difficult for NHS providers to maintain services or to invest in new technology and equipment. I have run out of time.

Oral Answers to Questions

John Leech Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.

[Mr John Leech (Manchester, Withington) (LD)]

11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.

[The Minister of State, Department of Health (Paul Burstow)]

Physiotherapy can help to manage the physical deterioration associated with muscular dystrophy and other neuromuscular conditions. Physiotherapists have a key role to play in reducing waiting times, improving access and choice, and providing more personalised services closer to home, thereby improving the quality of life of their patients. It is for local NHS organisations to decide how best to use the funds allocated to meet health needs.

[Mr Leech]

I thank my hon. Friend for his answer. Will he meet me and campaigners from the North West Muscle Group to discuss what actions need to be taken to ensure ongoing physiotherapy for patients with neuromuscular diseases?

[Paul Burstow]

I am grateful to my hon. Friend for that question, and I know that he plays an active part in the all-party muscular dystrophy group. He was involved in ensuring that we had a report from that body on access to specialist neuromuscular care—the Walton report, an important report that mapped out many of the deficiencies in the current service. I would be happy to meet him and his friends to discuss the matter further.

Rarer Cancers

John Leech Excerpts

Wednesday 27th October 2010 Westminster Hall

[Mr John Leech (]

Manchester, Withington) (LD): It is a pleasure to see you in the Chair this afternoon, Mr Robertson. I start by thanking my hon. Friend the Minister for contacting me in advance of the debate for an indication of the matters that I want to raise on a wide-ranging subject. The title is particularly wide. I also thank the numerous organisations that contacted me with information for the debate and apologise to those whose issues will not be addressed this afternoon.

In this short debate, I want to make some time available to my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti), who wants to say a few words, and to take the opportunity to raise two specific issues, the first of which is lack of awareness among MPs of the issues surrounding funding for the treatment of rarer cancers in general and the lack of understanding of the complex processes and institutions that make decisions about the availability of drugs, especially to sufferers of rarer cancers.

The second, related, topic is the recent health technology appraisal by the National Institute for Health and Clinical Excellence of the use of azacitidine for the treatment of myelodysplastic syndrome. That is a bit of a tongue twister, so I shall refer to it as MDS. NICE’s appraisal and decision-making process for azacitidine highlights the problems and inequalities facing sufferers of rarer cancers in getting access to what are often life-saving treatments. NICE’s refusal to recognise orphan drug status has created a great disparity in the treatment options for the sufferers of rarer cancers. With the move to value-based pricing not due to come into effect until 2014 and with the lack of details about how it will work, it is essential that that inequality is addressed.

The initial £50 million of funding from the cancer drugs fund has been distributed to the strategic health authorities, and today sees the opening of the consultation on the main cancer drugs fund. I suggest that today is the perfect day to restate the case for far greater funding for rarer cancers.

I start by mentioning the need for MPs to have a greater awareness of rarer cancers, and of the processes and institutions that evaluate the drugs needed to treat them. A number of patients and their family members attended the MDS UK lobby of Parliament yesterday. As part of that lobby, MDS UK launched the results of a survey, which showed that two thirds of MPs had no understanding of the term “health technology assessment”, and one third had no understanding of the term “quality-adjusted life year.” I confess that I was one of those people until I was contacted by MDS UK.

MPs are expected to have a broad knowledge of many subjects, but we cannot claim, or expect, to have a detailed knowledge of all subjects—some of our constituents may argue that we do not have much knowledge of any subjects. With large-scale reforms of the NHS due to be discussed and voted on, it is vital that MPs gain a greater knowledge of such subjects, and understand how those who suffer from rarer forms of cancer are currently discriminated against.

There is a need for greater awareness about how the details of value-based pricing and decisions on how to allocate the cancer drugs fund may, or may not, remove barriers to treatment for those with rarer cancers. I do not intend to spend any more time on that aspect of the debate, other than to highlight the rarer cancers toolkit collated by MDS UK, which I hope the Minister is aware of and has seen. Although today I am concentrating on MDS, there are other rare cancers such as pancreatic cancer, ovarian cancer or mesothelioma that also struggle with either a lack of access to drugs, or with the need to raise awareness among the general public.

I want to mention the fiasco surrounding the NICE appraisal of azacitidine. The process has already taken 18 months and, as a solution is not necessarily assured until March 2011, it may end up being a two-year process in total. In the meantime, up to 1,500 patients will have missed out on the opportunity to access azacitidine during that decision-making process.

The mishandling of the evidence by the evaluation team, as highlighted by the appeals committee, has not helped. The process is long-winded and ponderous even without an appeal. More worryingly, setting aside the length of time involved, the decision-making process itself is flawed, especially NICE’s refusal to recognise orphan drug status. The MDS Forum, the Royal College of Pathology and the British Society for Haematology, which collectively represent the UK’s top haematologists, have all written to NICE to highlight the unsuitability of NICE’s health technology assessments for considering orphan medicines. Haematologists from centres of excellence across Europe have signed a letter echoing that view. Of the 50 orphan-status drugs that are licensed by the European Medicines Agency, only three have been recommended by NICE.

There is an exceptionally strong case for further reform to the NICE process to ensure that it captures the full value of new and innovative medicines for patients with rarer cancers. It is widely accepted that there are problems with the NICE process and that it is unfair to those who suffer with rarer cancers. Extremely high costs are associated with the research and development of drugs, and the relative lack of expertise means that drugs for rarer conditions cost even more. The fact that some drugs are for small patient groups means that sales are relatively low, and the unit cost of such drugs is incredibly high. Nevertheless, the innovative value added by those drugs is great. They are not “me too” drugs, with a relatively low incremental clinical improvement to the patient compared with the drug that is replaced. Such drugs are unique and often provide the only treatment available to the patient. Azacitidine for MDS is a perfect example. The only alternative to it is usually “best supportive care”, which treats only the symptoms and not the disease.

I do not know why the process cannot be adjusted to take orphan status into account, and I would be grateful if the Minister could address that question in his response. It seems that the UK is almost unique in that decision. The problems with the NICE process are not unknown, and I know that the Minister and his Department are fully aware of them. The decision to move to value-based pricing, and the introduction of end-of-life criteria and patient access schemes are recognition of such problems. However, end-of-life criteria and patient access schemes have not succeeded in making appraisals more flexible to innovative treatments for rarer cancers, especially cancers where the small number of patients eligible to take part in trials means that there is often considerable uncertainty surrounding the data.

An interesting example of the current problems with NICE’s methodology is the fact that even if azacitidine were to be given to the patient for free, its quality-adjusted life year cost would still be £20,000. I do not understand how that can be the case; perhaps the Minister will explain.

Unfortunately, value-based pricing is more than three years away. That will be too late for some patients. Furthermore, the devil will be in the detail as to how the scheme will work and how effective it will be at addressing the needs of small patient groups. In the meantime, short of further reform of the NICE process, the only option for MDS patients and similarly disadvantaged sufferers of other rare cancers is the cancer drugs fund.

Before I move on to the cancer drugs fund, I urge the Minister to ensure that value-based pricing is constructed in such a way that drugs such as azacitidine become available to UK citizens, just as they are available across the rest of Europe. Azacitidine provides a vast improvement to patient outcomes compared with current treatments, and it is therefore the very definition of “high value”, which value-based pricing must be designed around.

I urge the Department of Health to ensure that the cancer drugs fund is used to help sufferers of cancers such as MDS. MDS is a life-threatening illness and it is terribly served by the NICE process. The only available treatment is currently being denied to patients, and although I hope that NICE reverses its decision, I fear that ministerial intervention may be needed to bring access to azacitidine to MDS sufferers. It is exactly the kind of treatment that the cancer drugs fund was designed to support and must provide for. Of course, MDS sufferers will have to wait even longer while NICE makes its decision, before they are even allowed to apply to the fund.

In conclusion, I urge the Minister to ensure that NICE methodology is reformed to make it more suitable for assessing medicines for rarer cancers, or that cancers such as MDS are taken out of the NICE health technology assessment process. I request value-based pricing to be constructed in a way that ensures that innovative drugs with a high benefit to patient outcome, such as azacitidine, are correctly appraised. In the meantime, I ask for the cancer drugs fund to be used to correct the inequality faced by sufferers of rarer cancers due to the disparity in the appraisal process of drugs for those rarer cancers.

Child and Adolescent Mental Health Services

John Leech Excerpts

Wednesday 7th July 2010 Westminster Hall

[Jonathan Reynolds]

Yes, it is difficult. To be clear, my point is that the prevalence and frequency of co-occurring mental health problems with autism require CAMHS professionals to have specialist training. Without that support, there can be misdiagnosis, which can lead to the situation that the hon. Gentleman referred to.

Does the Minister agree that, given the high proportion of children with autism who access CAMHS, all CAMHS professionals should receive some autism training?

I have explained how a basic knowledge of autism among all CAMHS staff is essential to ensuring that appropriate interventions are delivered to children with autism, but that alone is not enough. Providing mental health support to a child with autism is a specialist skill. Research has found that when an autism specialist has been involved in the support of a child, the outcomes and service satisfaction both improve dramatically.

The NAS found that parents who reported that their child had received support from a professional specialising in autism were twice as likely as those whose children had not to agree that CAMHS had improved their child’s mental health. They were also four times as likely to say that a good understanding of autism by mental health professionals had positively influenced their child’s mental health. However, only two in five parents say that their child has had such support.

[Mr John Leech (Manchester, Withington) (LD)]

I congratulate the hon. Gentleman on securing the debate. As a parent of an autistic child, does he support the idea that children on the autistic spectrum should be educated in special schools, or are such children better off in mainstream schools?

[Jonathan Reynolds]

Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.

The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.

Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.

Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.